Skip to main content
. 2019 May 1;94(7):803–811. doi: 10.1002/ajh.25484

Table 1.

Summary of National Comprehensive Cancer Network1 and European LeukemiaNet Guidelines for post‐remission therapy in patients with AML5

National Comprehensive Cancer Network
Patients aged <60 y with favorable risk • HiDAC 3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or
• Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin 60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive)
Patients aged <60 y with intermediate risk
  • Matched sibling or alternative donor HCT, or

  • HiDAC 1.5‐3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or

  • HiDAC 1.5‐3 g/m2 over 3 h every 12 h on days 1, 3, 5 or 1, 2, 3 with oral midostaurin 50 mg every 12 h on days 8‐21 (FLT3‐mutated AML), or

  • Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin 60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive)

Patients aged <60 y with treatment‐related disease other than CBF and/or with poor risk
  • Matched sibling or alternative donor HCT, or

  • HiDAC 1.5‐3 g/m2 every 12 h on days 1, 3, 5 or 1, 2, 3 × 3‐4 cycles, or

  • HiDAC 1.5‐3 g/m2 every 12 h on days 1, 3, 5 or 1, 2, 3 with oral midostaurin 50 mg every 12 h on days 8‐21 (FLT3‐mutated AML), or

  • Dual‐drug liposomal encapsulation cytarabine 65 mg/m2 and daunorubicin 29 mg/m2 on days 1 and 3 (cytotoxic therapy‐related AML or patients with antecedent MDS/CMML or cytogenetic changes consistent with MDS)

Patients aged ≥60 y with CR after intensive induction therapy
  • Reduced‐intensity HCT, or

  • Standard‐dose cytarabine with or without an anthracycline (idarubicin or daunorubicin) or intermediate‐dose cytarabine for 4‐6 doses for 1 or 2 cycles (if good performance status, normal renal function, better‐risk or normal karyotype and favorable molecular markers), or

  • Dual‐drug liposomal encapsulation cytarabine 65 mg/m2 and daunorubicin 29 mg/m2 on days 1 and 3 (cytotoxic therapy‐related AML or patients with antecedent MDS/CMML or cytogenetic changes consistent with MDS), or

  • Cytarabine 1000 mg/m2 every 12 h on days 1‐4 + daunorubicin

    60 mg/m2 on day 1 (first cycle) or days 1‐2 (second cycle) + gemtuzumab ozogamicin 3 mg/m2 on day 1 × 2 cycles (CD33‐positive), or

  • Maintenance therapy with hypomethylating agents (5‐azacitidine, decitabine) every 4‐6 weeks until progression (if patient received hypomethylating agents during induction)

Patients aged ≥60 y with CR after lower intensity therapy
  • Reduced‐intensity HCT

  • Hypomethylating agents (5‐azacitidine or decitabine) every 4‐6 weeks until progression

  • Gemtuzumab ozogamicin 2 mg/m2 on day 1 every 4 weeks up to 8 continuation courses (CD33‐positive)

  • Continue enasidenib (IDH2‐mutated AML) or ivosidenib (IDH1‐mutated AML) until progression

European LeukemiaNet
Younger patients (18–60/65 y)
Favorable risk genetics
  • 2 to 4 cycles of IDAC (1000‐1500 mg/m2 every 12 h, days 1‐3 or days 1‐5 or 6) additional therapy

  • Midostaurin for patients with FLT3 mutations (administered after the chemotherapy)

Intermediate risk genetics
  • Allogeneic HCT from matched‐related or unrelated donor, or

  • 2 to 4 cycles of IDAC, or

  • High‐dose therapy and autologous HCT

  • Midostaurin for patients with FLT3 mutations (administered after the chemotherapy)

Adverse risk genetics
  • Allogeneic HCT from matched‐related or unrelated donor

  • Midostaurin for patients with FLT3 mutations (administered after the chemotherapy)

Older patients (>60/65 y)
Favorable risk genetics
  • 2 to 3 cycles of IDAC (500‐1000 mg/m2 every 12 h, days 1‐3 or days 1‐5 or 6)

Intermediate/adverse risk genetics
  • No established value; consider allogeneic HCT with a low HCT‐Comorbidity Index, or investigational therapy

Abbreviations: AML, acute myeloid leukemia; CBF, core‐binding factor; CMML, chronic myelomonocytic leukemia; CR, complete remission; HiDAC, high‐dose cytarabine; HCT, hematopoietic cell transplant; IDAC, intermediate dose cytarabine; MDS, myelodysplastic syndrome.